Several Alabama dental clinics are operating in violation of state law, and are putting profits before patient care, according to a report released this week by the U.S. Senate Finance Committee.

Those clinics are performing unnecessary procedures to pay the corporate investors that own the clinics, the report states. The report recommends that state and federal agencies end that practice by enforcing existing laws.The 1,500-page report, put out by Sens. Charles Grassley, R-Iowa, and Max Baucus, D-Mont., marks the end of a two-year investigation into the practice of corporate dentistry by the staff of the Senate’s Committee on Finance.

Among the companies investigated was Aspen Dental, a nationwide chain of dental clinics that is opening an office in Oxford this year. Small Smiles dental clinic — one of the largest dental chains in the U.S. — operates clinics in Dothan and Montgomery, and is the center of much of the Senate investigation and report.

According to the report, Small Smiles, managed by Nashville-based Church Street Health Management, skirts laws in states — including Alabama’s Dental Practice Act — that ban dental clinics from being owned by anyone other than a licensed dentist.

The company does that by entering into contracts with “owner” dentists licensed in the state in which the clinic operates, according to the report. CSHM claims to only manage the clinics, the report’s authors write.

But the company retains control of daily operation, according to the report, from hiring, firing and training staff to controlling the bank account and setting production goals that require dentists to treat large numbers of mostly low-income children eligible for Medicaid.